Monday, May 17, 2010

The Long, Scary Weekend

For those that don't know already via facebook, Krista and I spent the last 4 days in the hospital trying to stop her contractions (pre-term labor). Krista has always had a lot of contractions during pregnancy. With Emma she started to notice them in the second trimester and we went to the hospital 4 times for treatment. None of those times required an overnight stay or any of the stronger drugs that they use to stop contractions. This time, however, things are a little different.

Krista started feeling contractions during week 13 (out of 40) of her pregnancy. For the last 6 weeks, she has had one long, nearly continuous run of moderately painful contractions involving back labor and a lot of pressure really low. We have been to the hospital twice to get injections of terbutilin to stop the contractions. The first time, a single shot, it worked for 36 hours. The second time, three shots, it worked for 8 hours. As of last Monday she was more or less ok and because her cervix was not changing we were in the clear and were expected to go full term still. We were still very watchful, but the level of risk and concern was fairly low because this was all similar to her first pregnancy. That is, until Friday.

After the second time in the hospital (the visit with the triple shot of terbutilin), she was given an oral drug to take at home once a day to control the contractions. This was a step above any treatment received for Emma's pregnancy. The idea was to take the drug at noon everyday for five days (afternoons were the worst for contractions) and reevaluation the following Monday. Krista was in the hospital before she could take her fifth dose.

Friday morning, she decided it was time to call the doctor. The oral pills had stopped working on Wednesday night. That night we drove to Matthews and she sat in the bike shop and tried to rest while I bought a new bike. It was more activity than she was used to at that point. The contractions started and we expected they would die down overnight on the medication. She continued to have contractions through Thursday and into Friday. She was also getting much more pressure on her cervix than she had experienced to that point and her back was sore from all the "back labor". She called the doctor on Friday to get an office visit that day but they were busy and said to just go to Labor & Delivery (L&D) in the hospital.

She called me Friday morning and I met her at the hospital. It didn't take long for the L&D nurses and the mid-wife to ratchet up her level of care. Previous visits we just stayed in the triage area and they monitored her and gave her the shots and monitored her some more and then released her. This time they immediately took a bunch of samples and started running tests looking for all kinds of infections or other signs that labor had started. When they examined her they also found that she had started to dilate, signaling cervical change. Over the next several hours we gradually ramped up the scale from weaker (but easiest on the patient) to stronger (but more side effects) anti-contraction medications. We also were rushed downstairs for an ultrasound to ensure the health of the baby.

This was the only real source of good news for the first two days of the hospital stay. Renner was happy and healthy. He actually measured large (5 lbs. 13 oz +/- 15 oz.). His size was consistent with a 35 week baby even though was only approaching 33 weeks. Part of this is explained by Krista's contractions. A baby under a lot of stress (ie. contractions for several months) develop extra cortisol, a steroid, and develop earlier than babies under lower stress. Nature's way of protecting at-risk pregnancies. The mid-wife and doctor were very encouraged by this.

Friday evening we were finally told we were not going home. The drugs to that point failed to put a dent in the contractions. She was still clicking through them at about 4 minutes apart and they were getting more painful. That night the decision was made to start the steroid treatments. Steroids are used to help the baby develop. Specifically, the goal is to improve the lungs so that if delivered early the baby will have a much reduced risk of post-partem problems related to breathing. The best situation is to give two shots of betamethasone separated by 24 hours. Then we would need to hold off delivery for 24 hours after the second shot for the baby to realize the most benefit from the shots. The first shot was given Friday night around midnight. That means our 48 hour window of no baby ended Sunday night at midnight if all went according to plan. Because none of the meds were slowing the contractions down, the doctors also decided to put her on the best drug for stopping contractions, Magnesium Sulfate (MgSO4).

This drug is nasty stuff. The list of side-effects is a mile long:

Side Effects

Side effects are common with magnesium sulfate and can affect both the mother and fetus. Side effects of magnesium sulfate that may affect the mother include:

These side effects can decrease over the duration of treatment and go away when the medicine is stopped.

And we experienced pretty much all of them. I have never seen a drug act so quickly. Almost immediately, Krista was showing signs of side effects. The next 24 hours was pretty brutal so I won't go into it. Needless to say, neither of us slept much Saturday night. She was bed bound at point because the drug prevents you from being able to control your muscles well and lowers your blood pressure so that you get very dizzy and nauseous from just sitting upright.

Even on the magnesium, Krista kept contracting. They had to up her dose twice to get enough into her blood stream to shut her uterus down. Finally, on Sunday, the contractions slowed down enough that the doctors were able to relax. We kind of maintained everything through Sunday and had a great visit from our daughter and her friends Lilia and Ezra. She went to stay with our friends and their kids on Friday and then we transferred her over to Grandma on Sunday. This was the longest Krista had gone without seeing Emma. Sunday night was better and Krista was able to sleep. Until 3 am that is.

At 3am the nurse came in and said she was really concerned about the baby and put Krista on oxygen and up'ed her fluid intake to get more sugars into her. She then went on a campaign with the doctor to get them to release Krista from the Magnesium drip early. We had already met our minimum time of midnight Sunday night, but we planned to wean her off in a more controlled manner at 7 am Monday. Finally, at 4 am the nurse got the call and she rushed in shut down the drip.

The concern for Renner was that his heart rate had fallen quite low compared to his normal from the previous three days and he was not very reactive. The magnesium makes mom and baby rather sluggish. Combine that with ambien (a sleep drug) and you get the picture. Basically, Renner was very groggy. He was still moving around, but our nurse was concerned. After a couple of hours, he was back to himself and perky as ever. We then transitioned Krista back to one of the mid-range contraction meds that she will have to take three times a day until she starts to deliver. Then we waited for the doctor to tell us what we wanted to hear, "You're free to go." Around 7 pm Monday we were on our way out of there.

Before I go, I want to say a word about our nurses and our care at the hospital. They were absolutely wonderful and made a very stressful, sleep-deprived experience much more bearable. One nurse spent Friday night with her hands on Krista's belly feeling for contractions because the monitor was not able to pick them up reliably enough and Krista was out of it with the medications she was on. Another spent two whole days practically not leaving our room taking care of our every need and being encouraging and listening and sharing stories about kids and pets. All of the nurses there were super helpful and on more than one occasion I woke up to find a nurse laying another warm blanket on me because of how cold the room had to be kept for Krista. We are extremely thankful for their efforts and almost look forward to seeing them again. If only our visits to their department could be less stressful.